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ResourcesMachine Readable FileThe machine-readable information is digital data that includes standard charges for all hospital items and services: gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiate charges. It is important to note that the charges provided may not reflect the actual amount an individual, or insurance company, or another responsible party will pay. The actual amount is determined by a variety of factors, including negotiated health plan rates, government rates, or upfront payment discount. Your responsibility may also vary depending on the type of care you receive, your insurance plan benefits, and how your insurance company processes the charges. The link below displays our machine-readable file in a .JSON format for your convenience. For each item and service, the file includes the description, common billing code, and standard charges: gross charges, discounted cash prices, payer-specific negotiated charges, de-identified minimum negotiated charges, and de-identified maximum negotiated charges.
Our ChargemasterChargemaster, also known as CDM, is designed to make our charges more transparent, accessible and easy for you to understand. The CDM is a comprehensive listing of items that could potentially be billed to a patient, insurance company or another responsible party. The chargemaster is a lengthy and complex document. It should not be used to accurately estimate or determine the final patient cost of a service. It is provided for informational purposes only. The charges in our CDM are the same for all patients, regardless of payer or plan benefits.
Our Average Charges by Diagnosis-Related GroupDiagnostic Related Groups, also known as DRG, is a system of classification for inpatient hospital services based on principal diagnosis, secondary diagnosis, surgical procedures, age, gender and presence of complications. This system of classification is used as a financing mechanism to reimburse hospitals and selected other healthcare professionals for services rendered. It is important to note that our CDM charges and average charges by DRG may not reflect the actual amount of reimbursement required from you, your insurance company or another responsible party. The reimbursement is determined by a variety of factors, including negotiated health plan rates, government rates, or upfront payment discount. Your responsibility may also vary, depending on the type of care you receive, your insurance plan benefits and how your insurance company processes the charges. The link below displays our CDM and average charges by DRG in PDF format for your convenience. For each service, the CDM includes an item number, item description and charge amount. (To download the file, right-click on the filename and pull down to "save link as..")
Billing FAQsMemorialCare accepts Visa, Mastercard, American Express, Discover Card, cash, checks, traveler's checks and money orders. You may call Patient Financial Services during our business office hours, Monday–Friday, 9 a.m. to 4 p.m. Phone Numbers. Payment is expected at the time services are rendered. However, MemorialCare provides short-term, interest-free payment plans. You can set up a short-term recurring payment plan through our payment portal or you can contact our office and a representative will be more than happy to assist you. In addition to anything your physician may ask you to bring in, please bring your insurance card, photo ID, and any other documents that will be useful in the registration and billing process. For example, you should bring in any referral or authorization form(s) that your primary care physician has provided to you. Please be prepared to pay any amount that will be due from you. If you don’t have insurance coverage you should receive a bill within 10 days. If you have insurance coverage, you will receive a bill once we have received payment or denial of payment from your insurance company. Depending on the type of insurance you have, you may be asked to pay your co-pay, deductible and/or coinsurance. The reason we ask for your insurance information every time you visit is that it gives us the opportunity to verify your insurance coverage and benefits to ensure that our records are accurate and up to date. Patients and/or employers change insurance carriers and plans with great frequency. By verifying your insurance each time, it helps us process your bill quickly and accurately. You may receive separate bills from physicians (including radiologists, surgeons, anesthesiologists and other specialists) and other providers involved in your care. No. Pathologists, radiologists, cardiologists, anesthesiologists, emergency room doctors and other specialists who provide services to you are required to submit separate bills. If you have any questions about these bills, please call the number printed on the statement you received. If you have certain tests or treatments, you may receive bills from physicians you did not see in person. These bills are for professional services rendered by the doctors in diagnosing and interpreting test results while you were a patient. Please notify us if you think your bill is inaccurate. Written disputes should be mailed to Patient Financial Services at P.O. Box 20894, Fountain Valley, CA 92728-0894. You can also fax to (714) 377-3572. If you are writing to us, please include:
If you wish to discuss your concerns with a representative, we invite you to call Patient Financial Services. If you do not have health insurance, you may qualify for a government program. You can contact our Patient Financial Services office and one of our representatives will be able to provide you with information regarding these programs. Government Programs
The hospital will submit your bills to your insurance company as a courtesy and will do everything possible to expedite your bill. But you should remember that your policy is a contract between you and your insurance company and you have the final responsibility for payment of your hospital bill. We have several payment options available to assist you in paying your bill. Co-pays and deductibles will be collected at the time of service, when possible. You will receive an Explanation of Benefits from your insurance company. The statement you receive from MemorialCare will show the most recent payments, adjustments and balance due, if any. If you are still uncertain, you can contact your insurance company directly; refer to your Explanation of Benefits or contact Patient Financial Services. It is your responsibility to contact your insurance company prior to having services provided to ensure that you understand your insurance benefits. If your insurance company’s requirements are not followed, you may be financially responsible for services rendered at the hospital. Some physician specialists may not participate in your healthcare plan and their services may not be covered. You can also estimate your out-of-pocket expenses by using the Patient Out of Pocket Estimator, simply locate Service, add insurance information and receive estimate. We make every effort to ensure your bill is paid appropriately. However, if we are unable to obtain payment from them, we will notify you that the bill remains unpaid. We will request that you contact your insurance company to expedite processing and payment of your bill. If your insurance company fails to make any payment on your account, we may seek payment from you. The Explanation of Benefits (EOB) you received from your insurance carrier explains in detail the services that were either paid or denied. If you need further assistance determining the reason(s) why your insurance company did not pay for your bill, please contact your insurance carrier directly. Your co-pay, deductible and/or coinsurance amounts are determined by the insurance plan in which you are enrolled. Please refer to your insurance benefits handbook. If you cannot find this information or have other questions, contact your insurance provider. You can also estimate your out-of-pocket expenses by using the Patient Out of Pocket Estimator, simply locate Service, add insurance information and receive estimate. It is the patient/guarantor’s responsibility to notify us which insurance is primary and which is secondary. MemorialCare will send a bill to your secondary insurance after the primary insurance has either paid or denied the bill. We recommend that you review your insurance policy and benefits before receiving medical services. If you are a Medicare patient, you will be asked a series of questions regarding your status including other insurance you may have; and your retirement. These questions are required by law and must be asked each time you visit us. If you are covered by Medicare, we will submit your bills to Medicare on your behalf. We are required by Medicare to provide only those services approved by Medicare as deemed medically necessary. In the event the service is not covered by Medicare, you will be asked to sign a notice that makes you financially responsible for the services provided. You will be responsible for services not covered by Medicare. Your account remained unpaid after several attempts to contact you. We use outside agencies to assist in the collection of unpaid accounts. What is the term used for a billing method in which bills are sent to some patients every week although each patient receives only one pill each month?What is the term used for a billing method in which bills are sent to some patients every week, although each patient receives only one bill each month? Cycle billing.
What is the difference between the patient ledger card and the patient statement?The difference between the Ledger Statment and Balance Statement. The Ledger Balance is an actual ledger (sum of payments and charges). The Statement Balance is the sum of charges that are billed to the client and the sum of the payments applied to those charges.
What is the purpose of the day sheet?day·sheet. A page that lists all health care procedures, payments, and adjustments for a single day; used in some accounting systems.
What types of services do PM systems offer?What types of services do PM software systems offer? PM software can offer electronic claims posting, statistics, and monthly or YTD billing information.
What is the purpose of patient statements quizlet?Patient statements are created to show the patient what's owed and why. This is to collect money from the patient, often for coinsurance purposes or for non-covered services.
What is the name of a patient bill that records services and charges for a specific time period?A billing statement is an itemization, or invoice, of the balance the patient owes for specific services.
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Which type of billing sends statements to patients at scheduled times throughout the year?
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